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South Carolina rates for HCPCS A4726

Dialysate Solution Any Concentration Of Dextrose Fluid Volume Greater Than 5999cc For Peritoneal Dialysis (Special Coverage Instructions Apply. See Mcm: 4270)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $35.00 / $35.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.40 / $59.40 / $59.40
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.00 / $35.00 / $59.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00